Quality Accounts 2010 / 2011 - NHS€¦ · Stoke‐on‐Trent Community Health Services Quality...
Transcript of Quality Accounts 2010 / 2011 - NHS€¦ · Stoke‐on‐Trent Community Health Services Quality...
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New Haywood Hospital Courtyard 2010
Quality Accounts Stoke‐on‐Trent Community Health Services Quality Accounts for 2010/11
Sarah Shingler Associate Director of Nursing and Operations/ Deputy Managing Director 31st March 2011
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CONTENTS PAGE
PART ONE: Statement of Quality 3
PART TWO: Priorities for Improvement 5
2.1 Principles of our Quality Improvement Strategy 5
2.2 2010/2011 Quality Improvement Priorities 6
2.3 How our quality priorities were decided and why they are our priorities 6
2.4 2011/2012 Quality Improvement Priorities 8
2.5 Review of Services 11
2.6 Account of 2010/2011 performance against national and Local Targets 11
2.7 Monthly Ward to Board Report 13
2.8 Goals agreed with Commissioners 15
2.9 Data Quality 17
PART THREE: Review of Quality Performance 18
3.1 Quality Objectives and Performance 18
3.2 Patient Safety 19
3.3 Patient Experience 28
3.4 Clinical Effectiveness 35
PART FOUR: Engagement 38
4.1 Open door access to Hospital Matrons 38
4.2 Patient Opinion Website 39
PART FIVE: Continually Learning 40
5.1 Participation in clinical audits 40
5.2 Participation in clinical research 40
5.3 Internal Audit 41
PART SIX: A Listening Organisation 45
6.1 Reporting Complaints and Compliments 45
PART SEVEN: Registration and External Review 48
7.1 Care Quality Commission 48
7.2 West Midlands Quality Review Service‐ Local health economy visit 48
7.3 Serious Case Review 48
PART EIGHT: Transparent and Open 50
8.1 Incident Reporting 50
8.2 Alerts 52
8.3 NHSLA 53
8.4 Learning from our Actions 53
PART NINE: Statements from Primary Care Trusts, Local Involvement Networks and Overview and Scrutiny Committees
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9.1 NHS Stoke‐on‐Trent 54
9.2 Staffordshire Health Overview and Scrutiny Committee 55
9.3 Stoke‐on‐Trent Health Overview and Scrutiny Committee 55
9.4 Staffordshire Local Involvement Network (LINk) 56
9.5 Stoke‐on‐Trent Local Involvement Network (LINk) 56
9.6 Stoke‐on‐Trent Community Health Voice 56
APPENDIX 1 – Clinical Trials
APPENDIX 2 – Glossary of Terms
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PART ONE
Statement of Quality
The main purpose of Stoke‐on‐Trent Community Health
Services (SoTCHS) is to provide high quality, clinically effective
healthcare services that meet our local population needs.
This report is the first set of Quality Accounts that the
organisation has published as mandated by the Department of
Health policy document ‘High Quality for All’. These accounts
demonstrate our performance against our own objectives and
against national and local targets and standards.
Last January (2010), SoT CHS Board agreed a Quality
Improvement Strategy which included our approach to
continuous quality improvement. This Quality Improvement
Strategy and our accounts focus on SoT CHS commitment to
making improvements in patient safety, patient experience and
clinical effectiveness. Linked to this we launched a patient
safety campaign that focussed the attention of the Board and
the organisation on improving our record of keeping people
safe and improving the patient experience.
The patient safety campaign focussed on three main areas; reducing health care acquired infections (HCAI),
reducing patient falls in both our community hospitals and in patients own homes and reducing the number of
community hospital acquired pressure sores. We also commenced a programme of patient safety walkabouts led
by members of the Executive Team.
A further strand of our patient safety campaign was to reduce the length of stay and numbers of delayed
discharges in our community hospitals enabling patients to be cared for in the right setting by the right
professionals. This has involved fundamental changes to the way in which we deliver our services and in how
clinical services work together. We have had some success however there is more work to be done in order to
allow our current emergency care system to cope with the demands which are being placed upon it.
The major focus of our attention in 2010/2011 has been in improving the experience of patients receiving our care.
We have implemented a real‐time in‐patient reporting system using patient experience trackers (PET) which means
we can closely monitor what our patients think about their care. We have introduced discharge questionnaires and
monthly follow‐up calls undertaken by the Hospital Matron to all patients discharged from our community beds.
We have achieved improvements over the year in patients’ overall satisfaction in care, improved communication
and how we ensured patients’ dignity and privacy.
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We believe that every patient has the right to receive high quality care that is safe, effective and respects their
privacy and dignity. We have declared compliance that mixed sex accommodation has been eliminated in our
organisation. Patients who are admitted to any of our community hospitals will only share the room where they
sleep with members of the same sex and same sex toilets, and bathrooms will be close to their bed area.
An important introduction across all clinical services in 2011/11 has been the introduction of Quality Assurance
Dashboards. The dashboards are considered at our Board and by the relevant clinical teams on a monthly basis.
Along with improving the quality of care for our patients, we also want to continue to be an organisation where
staff feel recognised and rewarded. We want staff to work within an environment where they are able to provide
nationally the highest quality of care possible. The organisation has continued to maintain its ‘can do’ attitude with
our staff survey results for 2010/2011 putting us in the top 20% nationally for 25 of the questions asked.
Last year saw the introduction of the CQUIN scheme (Commissioning for Quality, Improvement and Innovation).
Through this 1.5% of contract income from our commissioners was based on achieving a range of quality
improvements. These quality accounts contain a range of performance information showing where we have made
real improvements in patient safety, experience and outcomes and where we still have work to do to meet the
aspirations of our patients and our staff. Again, we have had significant success in attaining the required targets.
Improving the quality of our services and the experience of our patients is the role of every member of our staff.
We are on a continuous improvement journey and I am committed to ensuring that quality improvement is at the
heart of everything that we do as we move forward. The future is exciting for the organisation as we prepare to
join three other providers to form a NHS Community Trust. Subject to final Department of Health approval the
Community Trust will be formally established later this year, but will operate in shadow form from the 1st April
2011. The goal is to then become a Community Foundation Trust by 2013. Staffordshire and Stoke‐on‐Trent
Partnership NHS Trust will provide a comprehensive range of community health and social care services to the
825,000 residents of Staffordshire and to the 270,000 residents of Stoke‐on‐Trent.
My personal thanks to every member of staff as they have all contributed to continually improving the quality of
care for local people.
I hereby state that to the best of my knowledge the information contained within the Quality Accounts is accurate.
Mandy Donald
Managing Director
22nd April 2011
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PART TWO
Priorities for Improvement
2.1 Principles of our Quality Improvement Strategy
We are wholeheartedly committed to providing care
of the highest quality and where we fall short of this
aspiration we are determined to and will do better.
This determination comes from our strategic theme
‘people are at the centre of what we do’. Carers and
families are involved in discussions around how we
deliver and re‐design services to ensure that we are
providing effective care across the age continuum;
from children’s and young people’s services through
to adults and end of life. As a community provider it
is vital that we provide services that are closer to
home and in peoples own home wherever possible.
The Quality Improvement strategy supports the
organisations strategic aim to ‘sustain and expand
quality services that make a real difference’.
SoTCHS Board and the Executive Management Team
recognise the need to balance bold ambition and
transparency with engaging the organisation using a
refined quality framework and sound metrics as
summarised below:
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2.2 2010/2011 Quality Improvement Priorities Stoke‐on‐Trent CHS agreed a comprehensive set of corporate priorities for the year, several of which were
quality priorities. The key ones were to:
2.3 How our quality priorities were decided and why they are our priorities The Board and the Executive Team agreed a long list of priorities for quality improvement. A series of clinical
engagement workshops (involving Doctors, Nurses, Allied Health Professionals, non clinical staff, Non
Executive Directors and Patients/Carers) were delivered to determine what our stakeholders felt needed to
change in order to provide improved outcomes to the local population. The information from the workshops
was used to develop the Quality Improvement Strategy and was debated by the Executive Team who agreed
the priorities. In agreeing the priorities we considered what our patients, staff and stakeholders have told us.
The Quality Improvement Strategy is being implemented as part of the Strategic Plan. The strategy supports
the organisations strategic aim to ‘sustain and expand quality services that make a real difference’ (Stoke‐on‐
Trent Community Health Services Strategic Plan 2008‐2013).
The Quality and Patient Safety Committee monitors achievement of the strategy, quality objectives and the
associated operational work plans, this committee reports to the Clinical Governance Committee (CGC) and
Best Value Group. The Clinical Governance Committee holds the responsibility for providing assurance to
SoTCHS Board for the safety and quality of services provided for the local population. Delivery and review of
the strategy and associated plans is the responsibility of the Quality and Patient Safety Committee
underpinned by the governance and assurance procedures of the organisation. It is envisaged that the total
process will ensure quality and safety is reviewed as integral aspects of efficiency and cost.
The Quality and Patient Safety Committee cross references with the work of the Integrated Governance and
Performance Committee and the Best Value Group responsible for delivery of the QIPP programme. To
ensure that the quality and safety of services is paramount and that the tensions that may arise in the
management of operational activity and financial performance are mitigated and reported up to executive
management team.
In order to measure quality and to demonstrate improvements we feel that it is important that we embed the
reporting and monitoring of quality into trust performance management systems and use the annual plan as
the basis for board level performance indicators for quality improvement processes.
The Provider Board undertakes a quarterly review of clinical quality, based on the data in the Quality Ward to
Board Report, this is similar to the way in which we currently review financial performance.
Our Management and Governance structure provides a delivery mechanism for implementation of change and
assurance on risk, please see Figure 1 overleaf.
Improve the Patient Experience
Reduce the organisation’s MRSA ad Clostridium Infection rates
Continuous improvement in Quality and Patient Safety
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Figure 1
Management and Governance Structure:
Trust Board
Community Health Services Board
Integrated Quality
Committee Information Governance Committee
Strategic Risk Group
Clinical Risk ManagementCommittee
Adults and Children ’ s Safeguarding
Committee
Professional ExecutiveCommittee Audit Committee
Performance
Integrated Governance Committee
Clinical Governance Committee
Health and Safety Group
PPI and Engagement Committee
Stoke - on - Trent CHS
NHS Stoke on - Trent
Key
Task and Finish Groups
Infection Prevention
and Control and Medical Devices/
Decontamination Committee
Non Clinical Risk Committee
Integrated Governance & Performance
Quality & Patient SafetyCommittee
CQC Requirements Group
Stoke-on-Trent Trust PCT & Stoke-on-Trent Community Health Services Governance
Structure
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2.4 2011/2012 Quality Improvement Priorities
2.4.1 Introduction to Staffordshire and Stoke‐on‐Trent Partnership NHS Trust
Staffordshire and Stoke‐on‐Trent Partnership NHS Trust is committed to quality improvement being at the
heart of everything we do as we move forward on our journey to form the new community provider
organisation. The date for establishment is the 1st September 2011.
The new organisation will ensure that the effective governance of quality and safety is maintained during the
transition to the new organisational arrangements and that the new Board will operate best practice in
surveillance of quality and safety.
A quality work stream was set up in October 2010 as part of the Transforming Community Services project to
establish a new community provider organisation across Staffordshire and Stoke‐on‐Trent. The work stream
has lead officers from the four organisations who are preparing for the integration and are scoping functions
that need to be established for the new Trust to operate effectively. The objectives of the quality workstream
is to:
Early involvement and engagement with staff and patients from the three existing NHS provider organisations
(NHS Stoke‐on‐Trent, South Staffordshire PCT and NHS North Staffordshire) is helping shape the future vision
and values of the new Trust.
A clinical summit was held in February with 90 senior professional leads and clinical managers attending from
across Staffordshire and Stoke on Trent to set the scene for the development of a clinical strategy. This event
was the first in a series of three sessions to develop a year one strategy.
The Professional Forum is an Advisory committee to the Board which will drive and develop clinical and
professional strategy for the Trust through strategic representation collaborating on best practice and service
direction.
Ensure a documented handover from predecessor organisations
Ensure early peer review of highest‐risk services
Clinical engagement
Ensure that quality and safety systems are established in advance of the new organisation establishment by reporting and being accountable to the ‘shadow’ Board which will consider a Quality and Safety report at its first and subsequent meetings
Ensure that the new Board develops a new overarching Quality and Safety strategy for the new organisation.
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A review of the quality governance framework is also being undertaken which includes establishing a culture
where quality is measured and monitored for the organisation to evolve through learning from its
experiences. As we move forward a quality‐focused culture will be promoted that includes active leadership,
structured walk rounds, positive feedback to staff, listening, learning and being responsive to continually
improve the quality of services.
Maintaining and improving quality during the transition is critical to enable the new organisation to meet
some of the greatest challenges in the history of the NHS. Meeting this challenge, the Quality Innovation
Productivity and Prevention (QUIPP) challenge – is about achieving the highest possible value from the
resources allocated to the NHS. It is about improving quality whilst reducing cost by improving productivity
and redesigning services wherever possible. The scale of the challenge means that throughout the transition,
quality must remain our guiding principle and should act as the glue that binds the organisation together.
Whilst the new Partnership Trust is not in a position to conform to the key improvement priorities for the new
organisation until it has full engagement, it has commenced work with partners on explicit areas for the
coming year e.g. Quality Visits, Commissioning for Quality Innovation (CQUIN) Scheme for 2011/12, patient
safety systems and processes and clinical risk areas.
As the Executive and Non Executive Directors for the new Partnership Trust come into post over the next few
months the quality priorities for 2011/2012 will be developed. It is proposed that a series of workshops are
arranged to engage with staff, patients and other key stakeholders to agree the quality framework and
priorities.
Eight key objectives covering all aspects of the new Partnership Trust’s work have been proposed and are as
follows:
1. To deliver safer care
2. To improve patients’ privacy and dignity
3. To listen and respond to patients and members
4. To create the capacity required to deliver our services
5. To deliver cost improved plans whilst sustaining quality of service provision
6. To develop our workforce
7. To assure the Trust is well governed
8. To improve the integration of patient care across hospital and community settings
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Within these objectives five priorities will be developed for quality improvement covering patient experience,
patient safety and clinical effectiveness.
2.4.2 Transitional Phase
In the transitional phase to ensure that quality improvement continues SoTCHS will continue to implement the priorities identified in the Quality and Patient Safety Strategy until the priorities are agreed for the new organisation. The table below outlines these priorities:
Safety
1.
2.
Reduce falls and the impact of falls for people aged 65 and over
Implement modified early warning score process across wards
Effectiveness
1.
2.
Reduce number of Community Acquired Pressure Ulcers caused by SoTCHS
Reduce number of delayed discharges in Community Hospital Inpatient beds
Patient Experience
1.
2.
Improve the quality of the end of life for people in the care of SoTCHS
Further implementation of the Quality Assurance Ward to Board dashboard across all community services.
The monitoring and performance management of progress against achievement of these objectives will continue as per the process outlined in Section 2.3 until the 1st September 2011. It is then proposed that all on‐going quality priorities and initiatives will be transferred into the new Partnership Trust.
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2.5 Review of Services During 2010/11 Stoke‐on‐Trent Community Health Services provided 50 NHS services.
Stoke‐on‐Trent Community Health Services has reviewed all the data available to them on the quality of care
in 11 of these NHS services.
The income generated by the NHS services reviewed in 2010/11 represents 67% per cent of the total income
generated from the provision of the NHS services by Stoke‐on‐Trent Community Health Services for 2010/11.
2.6 Account of 2010/2011 performance against national and Local Targets
2.6.1 National Priorities
Measure Source of Data Performance
CQC registration
Care Quality Commission Achieved
Incidents of C Difficile (target of 7 cases)
Trust collected and reported 13 cases
Incidents of MRSA Bacteremia (target of zero)
Trust collected and reported 0 incidents
18 week referral to treatment times: Admitted patients (target 90%) Non‐admitted patients (target 95%)
Trust collected and reported 99.1%
96.3%
Maximum waiting time of 4 hours in A+E from arrival to admission, transfer or discharge (target 98%)
Trust collected and reported (Walk in Centre, Haywood)
100%
Access to Dexa diagnostic scans within 6 weeks (target 100%)
Trust collected and reported 100%
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2.6.2 Local Priorities and Clinical Outcomes
Measure Source of Data Performance
Incidents of Never Events (National Patient Safety Agency)
Trust collected and reported
Zero
Chlamydia Screening (target 35%)
Trust collected and reported
29% Awaiting Health Protection Agency confirmation of final figures
Childhood Obesity Training (target 95%)
Trust collected and reported
97%
HPV Immunisation (target 88%)
Trust collected and reported. Figure reported is for the financial year, however final figure is collated on academic year which is completed in July 2011
84% based on reporting for financial year
Breastfeeding at 6‐8 weeks: Coverage (target 85%) Prevalence (target 27%)
Trust collected and reported
95%
30%
Delayed transfers of care (target 7.5%)
Trust collected and reported *achievement at end of March – to be updated with cumulative figure)
1.6%
Average length of stay in hospital (target 50% reduction)
Trust collected and reported
28.73 days (March 2011) Reduced from 55 days (April 2010)
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Compliance with Single Sex Accommodation
Trust collected and reported
Achieved
No breaches
% of deaths occurring in preferred place (target 40%)
Trust collected and reported 38%
% of appointments lost to patients who cancelled or did not attend (target <10%)
Trust collected and reported
6.3% (March 2011)
Sickness and absence of staff (target 4.5%)
Trust collected and reported
5.46%
Data quality: Recording of NHS Number (target 95%) Recording of ethnicity (target 90%)
Trust collected and reported
99.9%
98.6%
2.7 Monthly Ward to Board Report
In order to support our aim to ensure that we deliver high quality nursing care a suite of nursing metrics have
been included in a Quality Assurance Dashboard which forms part of the monthly ward to board report.
The dashboard is used as a tool to engage and empower staff with ‘placing patients at the centre of everything
we do’, it also allows us to consistently deliver nursing care against the basic needs of patients as evidenced in
the graph on page 14. Some of the areas included in the dashboard are outlined below:
Nutrition assessments
Waterlow assessments
Falls assessments
Recording of baseline observations
Catheter care
Infection, prevention and control
Responding to complaints
Completion of daily care logs
Incident reporting
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The graph below illustrates an overall score for quality achievement, calculated from the monthly quality
dashboards collated by clinical teams across the organisation. Throughout the year additional services have
become part of the quality ward to board dashboard programme and the number of indicators have risen
dramatically. In April 2010 the organisation was measuring services against a core number of indicators that
provided approximately 180 indicators, by March 2011 this had risen to over 650.
The following services are included in the overall quality achievement measure presented above.
Service Measurement began
Hospital Matrons March 2010
Community Matrons August 2010
District Nursing Teams October 2010
District Nursing Ambulatory Care Clinics October 2010
Intermediate Care October 2010
Podiatry November 2010
Tissue Viability December 2010
* Medical and Dental not included
Overall achievement against the quality indicators has consistently been above 90%. Each indicator is
individually reported and monitored at Senior Nurse forums, Clinical Governance Committee and Service
Boards. Where performance has fallen below target action plans have been developed and Senior Managers
held to account for delivering improvements.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
April May June July Aug Sept Oct Nov Dec Jan Feb Mar
% Score
Month
% Quality achievement
% Quality achievement
The overall score for quality achievement is derived from a scoring system based on the number of indicators on target for achievement. The target for achievement in 2010/11 was 90%. Our ambition is to achieve consistent delivery of nursing care against patient’s basic needs. The results above demonstrate that we are achieving high standards; however there is still room for further improvement and this work will continue as part of the quality framework in the new Partnership Trust.
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2.8 Goals agreed with Commissioners
2.8.1 Use of the Commissioning for Quality and Innovation (CQUIN) Payment Framework
A proportion of SoTCHS income in 2010/2011 was conditional on achieving quality improvement and
innovation goals agreed between NHS Stoke on Trent and any person or body they entered into a contract,
agreement or arrangement with for the provision of NHS services, through Commissioning for Quality and
Innovation framework.
CQUIN targets this year were very ambitious and our clinical teams have demonstrated real commitment to
improving services through delivery of the CQUIN targets. The ‘End of Life’ and ‘Nutrition’ CQUINs have
proved to be particularly challenging due to the complex nature of how Community Services are delivered and
the organisational boundaries which our staff regularly work across.
However, we are extremely proud of our results this year and we will continue on our mission to further
improve the services which we deliver.
Further details of the agreed goals for 2010/2011 and for the following 12 month period are available
electronically at:
http://www.institute.nhs.uk/world_class_commissioning/pct_portalcquin.html
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CQUIN Number
CQUIN Subject
CQUIN Detail CQUIN Achieved /
1 Smoking 90% of smokers/tobacco users attending outpatient clinic appointments receiving a brief intervention.
2 Think Glucose
Effective participation in the NHS Institute Think Glucose Programme
All patients on admission should be assessed for risk.
Inpatients assessed to be at risk of ulceration or who currently have a pressure ulcer will have preventative actions taken and documented in a care plan.
Decrease on numbers of acute hospital acquired grade 2, 3 and 4 ulcerations
All hospital acquired ulcerations of grade 2, 3 or 4 will be recorded as an incident on the appropriate system.
3 Tissue Viability
All ulcerations which show deterioration will be recorded as an incident on the appropriate system.
Community Hospitals 4 Patient Experience Community Services
5 Infection Control ‐ MSSA
Reduction in % of patients with hospital acquired MSSA.
6 End of Life The number of patients who have died on a GSF register, have a supportive care plan in place and have managed on a supportive care pathway.
All patients will have a falls risk assessment completed using a recognised tool on admission to a community hospital within 24 hours. For those at risk, individualised falls care plan will be implemented and those identified as being at higher risk or have fallen should be referred to a more competent practitioner.
7 Falls Risk Assessment
All patients will have a falls risk assessment completed using a recognised tool on initial contact with the community team. For those at risk, individualised falls care plan will be implemented and those identified as being at higher risk or have fallen should be referred to a more competent practitioner.
8 Nutrition Adult patients will have a nutrition assessment completed on admission to community hospital or initial contact with community team. For those at risk an individualised care plan will be implemented.
9 Isolation 95% of inpatients requiring isolation (or cohort nursing if appropriate) due to suspected infectious vomiting and/or diarrhoea are isolated (or cohorted) within 2 hours of the clinical assessment actions cause is present.
NB. SOTCHS achieved 1/3 of the nutrition target therefore achieved £46k out of £138k, community matrons were the only service to achieve 100%, Hospitals achieved 87.5% for the assessment target and 100% for care plans, and unfortunately Intermediate Care failed both elements. The main issue why we failed this CQUIN was because of operational issues in relation to collection of patient records for audit purposes within given timescales as agreed with Commissioners. Unfortunately the smoking CQUIN was not also achieved even though we identified our smoking population from our outpatient clients, we did not document referral to smoking cessation.
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2.9 Data Quality
2.9.1 NHS Number and General Medical Practice Code Validity
SoTCHS realises the importance of holding good quality information which underpins the effective delivery of
patient care. Over the last 12 months we have made great strides working closely with clinical teams to improve
the use of clinical codes, the recording of ethnicity and the use of the NHS number.
SoTCHS submitted records during 2010/11 to the Secondary Uses service for inclusion in the Hospital Episode
Statistics which are included in the latest published data. The percentage of records in the published data which
included the patients valid NHS number was:
99.9 % for admitted patient care
99.9 % for outpatient care
99.8 % for patient care within the community
SoTCHS will be taking the following action to improve data quality:
To ensure that all measures are reported and monitored internally within the organisation via the Executive Board
and Service Boards who are held accountable for the recording of codes. These measures are also reported
externally to Commissioners.
SoTCHS has developed service level reports which allow teams and individuals to monitor their contribution and
data recording. Moving forward into 2011/12 these reports will be used to benchmark performance and
improvement against key indicators such as:
Late data entry
Uncoded contacts
Incorrect referrals
Level of activity
2.9.2 Information Governance Toolkit attainment levels
Stoke on Trent Primary Care Trust Information Governance Assessment Report score overall score for the reporting period of 1st April 2010 to the 31st March 2011 was 66% and was graded at Amber.
Report results
Assessment
Overall Score
Grade
Version 7 (2009‐2010)
66% AMBER
Version 6 (2008‐2009)
70% GREEN
Grade
RED Overall score in range 0‐39% (Version 7 or before)
AMBER Overall score in range 40‐69% (Version 7 or before)
GREEN Overall score in range 70‐100% (Version 7 or before)
SoTCHS has achieved level 2 in each of the 41 standards in the Information Governance Toolkit with 66% (satisfactory) overall score. This means that we can now report Information Governance Toolkit compliance. As an organisation we have successfully achieved 100% of the target set at the beginning of the year to archive level 2 in each of the 41 standards. SoTCHS will be ensuring continual level 2 compliance for the forthcoming year and will await further guidance from Version 9 of the Information Governance Toolkit that is due for publication in 2011/12.
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PART THREE REVIEW OF QUALITY PERFORMANCE
3.1 Quality Objectives and Performance
At the beginning of 2010 the organisation published 10 key objectives for the year 2010/2011. These included
many quality improvement initiatives and plans which are discussed in further detail, including performance
against them in these Quality Accounts.
This part of our Quality Accounts includes our progress against the quality objectives and priorities we set as part of
this process under the headings of patient safety, patient experience and clinical effectiveness. The table below
provides a snap shot of the quality objectives which we expected to achieve this year.
Meaningful and effective Patient and Public Engagement
Reduce MRSA Infection rates
Reduce C Difficile infections
Further enhance ward to board reports with improved sustainable compliance
Sustainable compliance with zero tolerance of mixed sex accommodation
Improved Incident reporting
Reduction in in‐patient falls
Reduction in degree of harm from in‐patient falls
Reduction in delayed discharges in community hospital beds
Reduction in Length of Stay in community hospitals
Reduction in community hospital acquired pressure sores
Improve direct contact time for trained staff through implementation of productive series
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We have made considerable progress through a number of programmes to improve quality over the last year.
We recognise that this is very much the beginning of our journey, but the new Partnership Trust has the both
the road map and the compass to allow us to reach our goal of achieving excellence in everything we do and
build on the impressive work which has already been achieved in SoTCHS.
3.2 Patient Safety
3.2.1 Infection Prevention and Control
The Health and Social Care Act (revised 2010) and specifically the Code of Practice for the NHS on the
prevention and control of healthcare associated infections and related guidance (commonly known as the
‘Hygiene Code’) seeks to ensure that infection prevention and control is embedded at every level of the
organisation. SoTCHS take this very seriously and we continue to strive for excellence in our infection
prevention and control practice and consequently our patients’ safety by working hard to reduce all avoidable
HCAIs.
Examples of evidence in delivering our infection, prevention and control objectives last year are:
Introduction of MRSA screening programme for all patients attending as an inpatient or as a day case
where anticipated length of stay was more than 4 hours
Audit the time from admission to MRSA screening
Introduce changes in aseptic technique
Implement the Infection Prediction Tool to identify high risk patients
Campaign ‘bare below the elbow’ and improve hand hygiene‐weekly hand hygiene audits across all in
patient areas
Anti microbial stewardship –use of local antimicrobial prescribing guidelines including regular risk
assessments
Root cause Analysis of all reported MRSA and C difficile infections
Ratification of C difficile Policy
MRSA Screening Compliance and time from admission to screening
In accordance with Department of Health Guidance all of our patients are screened on admission to detect
MRSA skin carriage (colonisation). The screening is undertaken using skin swabs for the presence of MRSA.
This allows us to offer decolonisation (skin disinfection) for affected patients. It is not possible to achieve
lifelong clearance of MRSA but in most cases we can achieve a window of opportunity which will allow patient
treatments to be conducted safely. Assessment and screening takes place as soon as possible following
admission.
SoTCHS are currently achieving around between 98 to 100% screening compliance for 2010‐2011. There was a
dip during February this year to 88% this has now improved again with 100% compliance reported for March
2011. The organisation is assured that the screening was undertaken for February but data could not be
accessed from the ward so this dip was untimely data submission rather than breach of guidelines/policy.
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MRSA positivity rates on admission range from 2% to 17.5%. It should be noted that most admissions to
SoTCHS wards are transfers in from other healthcare establishments.
Introduce changes to aseptic technique
The aseptic technique guidelines have been reviewed and with the exception of staff members on sick leave or
maternity leave all our trained nurses have undergone assessment of aseptic technique competencies. These were
undertaken by our Matrons and Infection Prevention and Control Nurse Specialist.
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Implement the Infection Prediction Tool to identify high risk patients
December 2009 saw the introduction of the Hospital Matron’s Quality Assurance dashboard and we now have
more than twelve months of data to reflect upon. The dashboard collates key performance indicators with regard
to Infection Prevention and Control for inpatient services. The dashboard is completed on a monthly basis by
nominated Hospital Matrons for their ward areas within the Community Hospitals including relevant outpatient
units.
The use of the dashboard provides assurance to the SoTCHS Board that key patient care activities are being
monitored; it also provides feedback for ward staff in relation to key topics.
Using a traffic light system for highlighting achievements, the dashboard allows our service users to assess the
quality of the services we provide.
Action plans are formulated at ward level to improve performance month on month. It also allows wards to
compare and contrast their results with others and share good practice and lessons learned.
Key performance measures from the dashboard are translated into a friendly format for public display on each
ward area.
Not all infections are avoidable, and some patients will be more susceptible to infection due to other existing
conditions.
All patients admitted to SoTCHS inpatient beds are risk assessed to determine any predisposing factors using
our Infection Prediction Tool (IPT) and the application of the IPT is key performance Indicator in the Quality
Dashboard
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Monthly hand hygiene audit completed 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
% compliance with hand washing technique 92% 96% 97% 99% 98% 95% 97% 100% 100% 99% 98% 98%
Monthly environmental audits - Hygiene Code 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
% compliance on all standards of the hygiene code (existing audit tool)
100% 99% 99% 99% 98% 99% 99% 99% 99% 99% 100% 100%
% of patients requiring isolation are isolated within 2 hours of the need being identified
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
All patients admitted will have been assessed using the infection control prediction tool
98% 100% 100% 98% 96% 100% 99% 100% 100% 99% 100% 100%
Campaign ‘bare below the elbow’ and improve hand hygiene‐weekly hand hygiene audits across all in
patient areas
Weekly hand hygiene audits are undertaken across all in patient areas, our targets are set very high at 100%
you can see the results reflected in the Quality Dashboard results above. Where there is under achievement
the Matrons and our Infection Prevention & Control Nurses offer more training and extra focus on the area.
Anti microbial stewardship – use of local antimicrobial prescribing guidelines including regular risk
assessments
The Infection Prevention and Control Nurses have strengthened their relationships in both primary care and
internal organisational medicines management groups. Negotiation has begun for the planning of
antimicrobial audits programme for inpatient areas for 2011‐12.
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Root Cause Analysis (RCA) of all reported MRSA and C difficile infections
We continue to undertake RCAs on all MRSA bacteraemia and C. difficile infections
In terms of MRSA bacteraemia SoTCHS has a zero tolerance, if cases have been reported a Root Cause Analysis
(RCA) would have been undertaken to establish cause, prevention of reoccurrence and to share any lessons
learned.
Cases of Clostridium difficile infections caused by toxin producing strains are also collated; SoTCHS locally
agreed target is based on a 10% year on year reduction. Whilst our targets have not been met on close
scrutiny of the RCAs undertaken for each case reported we find common trends. We found that most cases
were older people, having chronic underlying medical conditions requiring antibiotic therapy, with multiple
healthcare establishment admissions. All of these factors increase the risk of C. difficile infection. Several
specimens submitted to the laboratory did not fulfil the criteria for submission this has resulted in focused
update on C. difficile management for clinical staff in our inpatient areas.
Health Care Associated Infections (HCAIs)
The table below reports the last four years data on HCAIs, SoTCHS has requested and agreed local (internal to
the organisation) targets with commissioners for the past three years.
MSSA bacteraemia has been mandatorily reportable since April this year SoTCHS began collecting data since
April 2010 and agreed a local target of four cases with only three reported.
HCAIs 2007‐8 2008‐9 2009‐10 2010‐11
MRSA Bacteraemia No local target set Two cases reported
Local target set at zero No cases reported
Local target set at zero One case reported
Local target set at zero No cases reported
MSSA Bacteraemia Data not reported Data not reported Data not reported Local target set at four Three cases reported
Clostridium difficile infection
No local target set 13 cases reported
Local target set at nine cases 12 cases reported
Local target set at eight cases 10 cases reported
Local target set at seven cases 13 cases reported
Outbreaks of gastro intestinal illness
During 2010‐2011 ten outbreaks of infection occurred which resulted in temporary closure of wards to
admissions, discharges and transfers to other care settings. In total 10 wards were affected with 74 patients
and 36 staff members reporting symptoms. All the outbreaks were gastrointestinal infections with Noro virus
identified as the causal factor.
All outbreaks of infection in SoTCHS are subject to a Root Cause Analysis investigation. This allows
identification of the source of the outbreak, and ensures that good practice in outbreak management is
followed to assist in minimising the effect of the outbreak.
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3.2.2 Patient Environment Action Team (PEAT)
The Patient Environment Action Team (PEAT) audits took place in January this year at both Haywood and
Longton Hospitals in accordance with the national guidance which states that all NHS sites having more than
10 patient beds should be audited annually. Although PEAT audits are undertaken internally by multi
disciplinary teams the reports are submitted to the National Patient Safety Agency and can be verified by an
external audit team appointed by the Agency. The standards audited this year were patient environment,
patient food and privacy and dignity respectively. We are very proud of this year’s achievements with the
hospitals achieving excellent in all three standards.
2008 2009 2010
Longton Cottage Hospital
Haywood Hospital
Longton Cottage Hospital
Haywood Hospital
Longton Cottage Hospital
Haywood Hospital
Environment Excellent Good Excellent Good Excellent Excellent
Food Excellent Excellent Excellent Good Excellent Excellent
Privacy and Dignity Excellent Excellent Excellent Excellent
The IP&C Nurses have worked closely with the support services leads this year to develop and agree cleaning
schedules in accordance with the National Specification for Cleanliness. Cleaning schedules are displayed in the
Infection Prevention and Control notice boards at the entrance and exits of our inpatient areas and in the public
areas in our Health Centres and ‘Walk In’ Centres.
How did we do with our developmental work for 2010/11?
Patient held MRSA screening record and a risk alert system for patients with a high risk of CDI ‐there has been
some progress internal to our organisation but it has become clear that this should ideally be an across local
health economy initiative and we have further development work to do for 2011/12 with our partner
organisations including the acute trust
Hospital Matrons have succeeded in enhancing the use of single patient use equipment such as patient
movement sheets and slings.
Patient exit audits have been undertaken this year which include questions on hand hygiene compliance and
cleanliness of the environment
Enhanced surveillance reporting has commenced with MSSA bacteraemia and from April 2011 E. coli
bacteraemia.
Identified areas for improvement
Further development of the Patient held MRSA screening record and the risk alert for higher risk of C. difficile
patients
Agree antimicrobial prescribing audits in our inpatient areas
There is more sensitive and specific laboratory testing for C. difficile in that we are able to ascertain genetic
relationship as well as toxin positivity. We will report both testing figures in our local surveillance reports
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New Initiatives for 2011/12
Health economy wide work (Community and Acute Trust partners and Specialist Nurses) specifically
infection prevention and control input regards the insertion, management and care of urinary catheters.
Include new KPI in Matrons Quality Dashboard regards insertion and management of urinary catheters in
inpatient areas
Health economy wide work (Community and Acute Trust partners and specialist Nurses) specifically
infection prevention and control input regards the management of chronic wounds and pressure ulcers
Agree antimicrobial prescribing audit for non medical prescribers
Enhance infection prevention and control assistance and support to independent contractors and the
independent and social care sector
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3.2.3 Falls
Leading in Patient Safety (LIPS) by the NHS Institute for Innovation and Improvement methodology has been
incorporated within clinical practice to provide timely outcome measures of service improvements. The LIPS
falls collaborative aims to decrease the levels of severity within falls by 20% and introduce a falls pathway of
clinical effectiveness across the organisation of SoTCHS in compliance to NICE guidelines and National
standards through engagement of frontline clinicians.
Multiple service improvements implemented across the organisation within the leading in patient safety
initiative will also interlink and be a fundamental component of the Quality Improvement Programme for the
new Partnership Trust.
From April 2010 to March 2011 we have been able to collate a baseline for the number of falls occurring
across the organisation. Across our two Community Hospitals sites we have had 432 falls incidents reported.
From the reporting we can identify that 68% of the patients fallen, sustained no harm or injury. 29% of
patients were identified as minor harm which could relate to a skin tear or bruise following a fall, a further 3%
of the falls were classified as moderate harm. The data clearly identifies that within the specific timescale
there were no patients that sustained any major or catastrophic injuries due to falls.
Within the incident reporting we can clearly identify through patient medical conditions numbers of recurrent
fallers. Our patients have multiple medical conditions, for example, dementia, confusion, cognitive
impairment. Valuable research and service improvements have been embedded within clinical practice in
order to reduce the harm rates and number of falls in accordance with best practice for this vulnerable group
of patients.
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Examples of service improvements to reduce falls within SoTCHS:
Introduction of a Falls Policy and Clinical Guidelines of best practice within falls, including standardised
falls assessment tool
The introduction of accredited Otago Falls Exercise Leaders through the extension of Support Workers
Roles
Otago Exercise Leader Falls Outcome Tool
The introduction of a Standardised Falls Education Programme
Post Falls Examination which is a standardised head to toe assessment upon every patient who has fallen.
Standardised incident and reporting mechanism for every fall.
Half hour falls observational chart for every patient at high risk of falling.
Convex mirrors and 360 degree mirrors upon the corridors and within hard to observe areas of the ward,
the mirrors act as observational nursing tools.
Falls Exercise groups and 1:1 sessions
Cognitive Behavioural Strategies of rummage boxes, visual prompts for patients dependent upon their
care need.
Close partnership across the health economy with multi‐agencies of fire, police, and Social Care,
Ambulance Service Voluntary and Independent sectors through the Leading in Patient Safety monthly Falls
Collaborative.
The dedicated and committed staff of SoTCHS have been instrumental within the service improvements and in
their commitment to change clinical practice to reduce the severity of harm of any patient who may fall within
our care. From the drive of change management we can clearly identify a decrease with the severity of harm
for patients within our care.
3.2.4 Modified Early Warning Scores (MEWS) in Community Hospitals
MEWS is a nationally recognised tool used to enable the early recognition that a patients condition has
changed or that they are starting to deteriorate. The score indicates the level of deterioration and triggers
that an action needs to be taken, for example urgent review by a clinician. The score is calculated by clinical
staff taking recordings of vital signs such as blood pressure, temperature, oxygen levels, urine output and
respiratory rate. Each reading giving a score which are then added together to give a total MEWS score.
Within SoTCHS Community Hospital inpatient ward areas, it was felt that there would always be the possibility
of a patient condition changing due to current health status and/or other medical conditions, especially in the
frail elderly population.
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MEWS implementation was felt to be a priority to implement across all wards and following staff training the
first pilot site at Longton Cottage Hospital was launched in December 2010. The pilot was successful proven by
staff feedback, patient stories. Outcome measures have been set and are monitored each month by the
Matrons Quality Assurance Dashboards these include monitoring of the:
o Number of re‐admissions back into the acute hospital
o Number of requests for clinician review both in‐hours and out of hours
o length of stay
MEWS is now to be rolled out across all wards within SoTCHS monitored by the Quality and Patient Safety
Committee.
Real patient stories include:
Over the weekend Mrs X was scoring 4 on the
MEWS when her baseline had previously
been recorded at 0. Her temperature was
raised slightly, as was her blood pressure and
respiratory rate. The nurse suspected early
signs of a chest infection and called an out of
hours Doctor to review. Mrs X was started on
oral antibiotics.
This early intervention prompted by the use
of MEWS prevented the lady becoming more
physically unwell and enabled her to remain
in a Community Hospital bed and not be
transferred back into the Acute Hospital. The
chest infection resolved within a few days.
Mrs Y had an episode of vomiting and her MEWS score was recording 3 due to a drop in her blood
pressure and a decrease in urine output. This was thought to indicate that she was becoming slightly
dehydrated and as a result intravenous fluids were commenced. The next day her MEWS score returned
back to 0 and Mrs Y was cared for closer to home in a Community Hospital setting, where as previously the
change in condition may not have been picked up as early, leading to further deterioration and a
readmission back into an acute setting.
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3.3 Patient Experience
3.3.1 Patient Experience CQUIN
As part of the CQUIN patient experience indicator SoTCHS was required to undertake two surveys across the
Community Hospitals and Services. A baseline survey was undertaken in July 2010 with a follow up survey
undertaken in February 2010 to measure improvement.
The organisation achieved positive results from the baseline survey but took into account the comments made by
patients. The comments were grouped into themes and improvement action plans were developed across
Community Hospitals and Services for implementation and monitored through the Quality and Patient Safety
Committee. The main themes were around communication and the providing of information to patients. There
were also many positive comments received in relation to patients being satisfied with the care and treatment that
they had received.
In order to achieve the full CQUIN payment the results needed to demonstrate improvements in 5 out of the 6
questions for community services and 4 out of the 5 questions for hospitals. The organisation was successful in
making these improvements, however further action plans are being put into place in order to sustain and
continually improve the quality of the services that we deliver.
3.3.2 Walking in Our Patients Shoes
“Walking in our Patients Shoes” has provided assurance to SoTCHS Board in accordance to the Quality
Improvement Strategy and Framework 2010‐2013 which aims “to sustain and expand quality services that
make a real difference”.
SoTCHS introduced the Department of Health
National and Regional Strategic Health’s Authority
Patient Experience Programme. Active engagement
workshops were scheduled with frontline staff and
members of the general public. The main aim of the
quality workshops was to proactively drive change
management through commitment of a bottom up
approach through the patient’s experience of health
care services. By capturing the basic patient
experience and identifying service improvements
devised by staff and our customers we have
influenced behavioural and cultural changes
throughout the organisation.
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Comments from members of the General Public upon Walking in Our Patients Shoes
Service Improvements identified by general public and staff
“I really enjoyed the workshop
what people expect and want
to receive from NHS”
“I don’t want to hear about the cost of NHS services but more about the quality and effectiveness of what I will receive”
“The majority of service
improvements would not
cost a lot because it’s just
basic expectations with
Customer Services”
“I really enjoyed the
workshop and felt that I was
listened to”
Changes to the process within written
appointments to include maps,
information on parking along with
information upon what people need
to bring upon appointments
Posters in the waiting areas that clearly state Health Administrators will update and provide an explanation to patients who experience any delays with
appointment times.
The option to access adequate
changing facilities for physically
disabled people and their carers
within all health care provisions
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3.3.3 Productive Community Services
Productive Community Services is an organisation‐wide change programme which facilitates systematic engagement of all front line teams in improving quality and productivity.
It is a practical application of lean based techniques that will vastly increase the organisation’s capacity and capability for continuous improvement.
The introduction of the Productive Community Series
has initially been showcased with two District Nurse
teams. The introduction of Productive Community
Series has been interlinked to the Quality Improvement
Productivity Programme (QIPP) to ensure the provision
of community services that the people of Stoke‐on‐
Trent value and choose to receive.
To sustain the achievements of the two teams within a
Productive Community Series a dashboard has been
devised as a fundamental visual sustainability tool for
monitoring and reporting for each of the teams. Every
two months two new teams will be enrolled onto the
PCS programme across all community teams and
professions.
Following the introduction of the Productive Community Series the two teams were identified at 34% of direct face
to face time to care. Following an activity analysis along with a skill mix review an ambitious target has been set to
increase efficiency and productivity within face to face time to care performance target of 45%.
Due to skill mix and review of organisation process and systems the target has been set for the district nursing
teams to decrease non patient activities to 20% to demonstrate service improvements due to allocation of skill mix
and duties within each team.
To ensure effective and quality services closer to home through neighbourhood working, two small district nursing
teams based at Hanley and Moorcroft Medical Centre have been amalgamated to form the Huntbach Street district
nursing team.
The individual team has been set a target to further reduce the three monthly mileages by a further five percent or
51.79 miles. Huntbach Street mileage for three months is recorded at 1079.13 the team has been set a target to
reduce their mileage by 15% or 161.87 miles within three months.
From the Boot/ bag amnesty the teams have introduced a standardised equipment list for each home visit bag with
an allocation budget of £29.00 for every staff member. The team leaders will audit and provide sustainability
through random monthly audits of any staff members nursing bags or boot.
The introduction of service improvements within Telehealth will increase productivity by enabling patients to
receive texts upon ‘Did Not Attend’ (DNA) rates along with empowering patients through preventative services of
blood pressure, glucose monitoring or oxygen saturation levels that engage patients within preventive services.
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3.3.4 Productive Ward
The Productive Ward focuses on improving ward processes and environments to help nurses and therapists
spend more time delivering patient care thereby improving safety and efficiency.
SoTCHS has eight inpatient wards within two
Community Hospitals. These ward areas have
been separated into two teams initially in order
to undertake this process of review into the care
delivered and the time spent with our patient
groups.
Team One have completed the Foundation
Modules and have commenced the first of seven
specific modules, the Meals Module, of which
looks at the current meal delivery service and
identifies how it may be improved to ensure that
patients receive a satisfying meal of their choice.
This module is on target to be completed by 30th April 2011. Team Two are currently undertaking the final element
of the Foundation Modules, the Activity Follows of which identifies how much time nursing staff currently spend
with their patients during an eight hour shift. This element for Team Two is on target to be completed by 30th April
2011.
Once all activity follows have been completed an overall average % Direct Contact Time (DCT) will be recalculated
and this figure will form the baseline on which to improve.
From the 30th April 2011 all wards will join together to progress through the Productive Ward Modules for example
reviewing the medicine round, the admission and discharge processes, patient hygiene, nursing procedures, staff
communication and others. These modules will enable the ward staff to review all their processes to identify
where improvements can be made and therefore enhance and increase the quality time nursing staff can spend
with their patients. Outcomes for Productive Ward include:
Health Care Support Worker Face to face activity to be increased by 20%, measured on a quarterly basis
Registered Nurse Face to face activity to be increased by 20%, measured on a quarterly basis
Monthly saving on ward supplies – Collation by Ward Managers – Monthly
Expected date of discharge/review, recorded for each patient – collation by Ward Manager ascertained from Quality Assurance dashboard
3.3.5 Receiving Feedback
Patient feedback is essential for wards to monitor the care being delivered thus enabling learning or service
changes where things could have been better but also to gauge what is being well received. Within ward areas the
patient experience is collected using several methods co‐ordinated by the designated Hospital Matrons.
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Matrons Walkabouts
Each Matron completes regular walkabouts of their designated wards speaking with patients, carers, relatives
regarding their stay and answering any queries or questions regarding their care. Matrons record all feedback from
these walkabouts and take actions as necessary and record any compliments. Example feedback includes:
“I could not of have been treated any better, no matter what, thank you Matron” 16 February 2011.
“Can I just say what a lovely hospital you have and staff are really friendly every time I visit and the atmosphere so relaxed” 28 March 2011.
“Really like privacy of single rooms after eight moves at the other hospital”. Flexible visiting discussed for relative working unsociable hours, plus alternative meal choices. 4 April 2011.
As a result of receiving feedback the wards have introduced “Next of Kin” documentation sheets which are held
within the patient notes. This indentifies all family members involved in the rehabilitation of the patient, detailing
meetings attended and communication. This provides a clear line of communication and full involvement
throughout the care of the patient. The patient must consent to this form of communication strategy.
The wards also host patient and family education groups where various health and well being topics are discussed,
there is an open invitation to families, carers and staff. Specialist speakers are also invited to provide education
and information around specific long term conditions.
Discharge Questionnaires
All inpatients are asked to complete a questionnaire on discharge regarding their stay. This is optional however
most patients do take the opportunity to provide feedback. There are key questions some examples include:
Hand washing compliance
Cleanliness of the environment
Being treated with privacy and respect
Being felt welcomed to the ward
Information being given regarding discharge arrangements and medications.
The results are collated monthly and individual wards have to produce action plans in order to ensure continual
improvement of these key measures.
All of the above patient experience measures are discussed and received at Hospital Service Board for monitoring
purposes.
Discharge Follow up Phone Calls
The Hospital Matrons will call all patients one month following their discharge in order to ensure they are coping
with the discharge arrangements made for them and also to ask questions regarding their experiences during their
stay. Matrons record all feedback from these calls and in some cases may take immediate action if a patient is not
coping, for example making a call to social care or asking for therapy review. Compliments are also recorded as
part of this process.
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Example feedback includes:
“Very happy with the staff at Longton Cottage I could not have gone anywhere better. I enjoyed the food. I am
doing well at home and carers have now stopped coming in but District Nurses’ still do. I am slowly but surely
getter better” March 2011.
“Spoke with nephew his uncle is doing very well and they were both more than happy with the care at LCH”
March 2011.
“I really enjoyed my stay at Longton. The food was lovely and I could not fault any of the Doctors or nurses. I had
nice company, thank you for the call Matron. Carers still come in once a day and a review of my stockings is being
planned by GP and District Nurse this week” February 2011.
Kiosks
In March 2011 the organisation introduced free standing Kiosks within outpatient services, health centres and
community hospitals that capture real time data on patients, families, and carer’s experience of services. The kiosks
are adjustable in height for wheelchair users and have a touch screen facility that is easily accessible for patients
with a physical disability. The kiosks are located in sight of reception facilities in case members of the general public
need help or support from health care administrators.
The computerised software will provide monthly reporting of real time data to each service board for analysis and
action plans of service improvement. Service Managers will be able to access and monitor the targets and
performance of community teams at any time through the website database. The introduction of the kiosks limits
any issues of bias as the collating, analysis and data is independently collected by computerised software.
Hand Held Portable Devices
Due to the end of the contract of the Patient Experience Trackers which previously captured real time data on the
patient experience. The organisation has purchased fifty hand held portable devices for distribution across service
divisions. The durable hand held devices will capture real time patient experience through a touch screen for key
patient experience priorities. The hand held devices will capture data from patients or families within their own
homes or patients who are bed bound. Data will be collated through wireless internet connections to the
computerised website. The computerised software is the same as the elephant kiosks which will provide the same
reporting mechanisms and limits any issues of bias through independent computerised real time data collection.
3.3.6 Stoke‐on‐Trent Community Health Services Real Time Quality Monitoring Visits
Real time quality monitoring visits have been undertaken by Executives, Non Executive Directors or members
of the Senior Management Team. The purpose of the visits is to provide the NHS Stoke‐on‐Trent Trust Board
with opportunities to review the quality and safety of services commissioned within the hospitals and
community services, exploring the views of patients and staff.
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Eight announced quality visits have been undertaken from August 2010 to January 2011. The overall
comments received from the real time quality visits identified are outlined below:
Clinical and non clinical staff behaved in a professional manner and were welcoming to patients and carers.
Patients reported that they were treated with dignity and respect identifying satisfaction with their treatment and outcomes.
Relatives identified that they felt involved in the care of their family members.
Infection control and quality patient information were clearly displayed within notice boards within the public domain.
Best practice within the monitoring of nutrition and hydration was clearly identified by patients.
Praise for staff was wholehearted with patients describing the care as first class along with comments of the kindness that they have experienced.
Clean and pleasant care environments.
Observations of deep cleaning whilst patients were not in their individual rooms.
Evidence when talking to staff that the care is clearly centred on the patient.
Staff identified they would like onsite statutory and mandatory training rather than going to offsite venues.
Service improvements identified and actioned:
A review of patient information and leaflets. From the quality visit the provider has purchased new magazine racks and weekly reviews of all patient information.
Increase within domestic services to remove used cups and debris left on the floor and tables within waiting areas in the walk in centre.
Review of patient information to ensure all information is presented in a more patient friendly manner.
The repositioning of a television in a ward dayroom due to the height and comments received by patients.
The real time quality monitoring visits have been well received by all the staff and have helped confirm the
excellent work and commitment of staff along with identifying areas of service improvement.
3.3.7 Delivering Same Sex Accommodation
SoTCHS believes every patient has the right to receive high quality care that is safe, effective and respects
their privacy and dignity. We are committed to providing every patient with same sex accommodation,
because it helps to safeguard their privacy and dignity when they are often at their most vulnerable.
SoTCHS is pleased to confirm that we are compliant with the Government’s requirement to eliminate mixed‐
sex accommodation, except when it is in the patient’s overall best interest, or reflects their personal choice.
We have the necessary facilities, resources and culture to ensure that patients who are admitted to our
hospitals will only share the room where they sleep with members of the same sex, and same‐sex toilets and
bathrooms will be close to their bed area.
Sharing with members of the opposite sex will only happen in our bathrooms when clinically necessary (for
example where patients need to utilise specialist bathing equipment) however we will ensure that privacy and
dignity will be maintained at all times. If our care should fall short of the required standard, we will report it.
We have set up an audit mechanism to make sure that we do not misclassify any of our reports.
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3.4 Clinical Effectiveness
3.4.1 Bed Occupancy
In the trust we recognize that bed occupancy is a clear indication of the quality of care which we provide. Targets
for occupancy were set for 2010/11 in line with national best practice, and a number of drivers were put in place to
achieve these targets. Notwithstanding the bed based services have found this particular target incredibly
challenging, with whole system factors creating pressure to admit patients as soon as a bed becomes vacant. The
following figure charts the trusts bed occupancy for 2010/2011.
* NOTE: On one ward 11 beds were closed due to essential maintenance works between October 2010 and January 2011.
In light of the above the trust have put in place a number of actions for the forthcoming year, actions which are outcome focused for the patient and in turn with success will have a positive impact on bed occupancy. In addition the trust now has a robust monitoring system in place which gives an early warning indication when bed occupancy reaches unacceptable limits.
3.4.2 Discharge Planning
Throughout 2010/11 the Trust has worked hard to ensure that all patients have an Estimated Date of Discharge (EDD) on admission (or within the first 48 hours), whilst this has been achieved throughout the year it has also been recognised that to set arbitrary EDDs does not in fact improve the patients experience. Therefore work is underway with ward staff to promote “meaningful” discharge plans, involving patients in discussion with outcomes they wish to achieve and the time in which they wish to achieve by. The above formally recognized as “lean discharge” principles will continue to be a clear area of focus throughout 2011/12.
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In line with the above, the reduction of patient’s length of stay has received concerted and dedicated effort
throughout the year. Bearing in mind that the trust operates a number of bed based services from intermediate
care to neuro rehabilitation, each having their individual nuances, reducing length of stay has its own complexity in
each area. However, throughout the year and with robust action plans the organisation has achieved in reducing
LOS by 26 days from April 2010.
3.4.3 Care Capacity Management Team (CCMT)
The Care Capacity Management Team has been in operation since May 2010 and was set up to help improve
patient flow, support discharge and timely referrals to other health and social care services across the Community
Hospitals. In addition the team do screen all referrals into bed based services in order for the patient to be in
receipt of the best possible care for their needs. It is without doubt that the team have been instrumental in
successfully reducing length of stay but equally driving up the quality of the discharge, which is evidenced by the
post discharge (follow up telephone calls) surveys.
In addition fundamental lessons have been learned throughout the year by way of the care capacity management
function, significantly that there is a fine balance between taking discharge away from ward staff and not
supporting staff with discharge planning. And whilst the model has changed slightly throughout the year,
amending and growing throughout, as the trust goes into 2011/12 it goes forward with a much more robust care
capacity management function. In effect each ward now has its own dedicated Discharge Support Worker all of
which are supported by both ward managers and qualified nurses from the CCMT.
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3.4.4 Emergency Pressures
Increased pressure was put on the CCMT throughout the winter period, both in terms of bed occupancy and length
of stay. In order to maintain throughput and add further support to the system the trust ran with a number of
additional multi‐disciplinary ward rounds twice weekly. These ward rounds included senior members of both
clinical and management staff and were carried out to help ward staff with “blocks” outside of their sphere of
control. The net effect and clear outcome was a reduction in the number of delayed transfers of care, which
proved to be running at the lowest throughout this winter compared with previous years.
3.4.5 Complex Care
SoTCHS recognised that with increased throughput and more appropriate referrals that an increased number of
patients were being admitted for a complex assessment for their future care needs. We also recognized that the
sensitivity of making life changing decisions for future care needs, including going into a nursing home, should not
be carried out in acute hospital settings. The vision for complex care, based upon what our patients were saying,
was to provide a dedicated service whereby patients could be supported through the complex care assessment
process in an environment conducive to their needs and with staff who are experienced in such. From February
2011, the Complex Care Unit was introduced, a baseline audit is currently being undertaken to examine what
changes we need to make to improve the assessment process and improve the experience for our patients and
families.
Throughout 2011 required changes will be put into place and performance monitoring against agreed outcome
measures will be completed and reported through the Hospital Service Board.
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Last Year you said…….
People identified issues relating to the planning of activities around appointments, parking, along with the cost to attend simple outpatient treatments within the Acute Hospital Services.
Last Year you said…….
That you would like or want your precious family members to receive choice within their end of life case management through respectful and dignified Community Services”
PART FOUR Engagement
4.1 Open Door Access to Hospital Matrons
Within both Community Hospital sites of the
Haywood and Longton Cottage Hospital the Matrons
have an open door policy which enables patients,
families or carers to have direct access to discuss
their patient/ family experience with the Matrons.
The Matrons visit every ward daily monitoring the
quality of care and collating information upon the
patients and family experience requesting
recommendations for service improvements.
Following engagement and consultation with “our
customers” we have actively listened and changed
service provisions.
Through prioritising people’s comments upon patient’s needs and expectation of SoTCHS in health centres closer to
home. We have made the following improvements.
We did…….
“We introduced ambulatory clinics within local health
centres closer to home. People are now able to gain
sub cut frusemide treatments within a timely manner
and continue with day to day activities rather than
attending the acute hospital”
We did…….
We have introduced Palliative Care District Nurse Champions who are skilled to provide palliative care treatment, advice and support. The palliative care District Nurse Champions are privileged to work in partnership with Patients, Families and Carers through providing quality end of life community services
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Last Year you said…….
That if you or members of your family are medically
unwell you would prefer to have assessments and
medical treatment within your own homes rather than
long waiting times and putting adverse pressure upon
the local A&E department”
4.2 Patient Opinion Website
The introduction of the Patient Opinion Website has empowered people to voice their opinions or views of their
own patient experience through an internet web based connection. The website provides the organisation with an
alert that a comment has been placed onto the website. The organisation is able to provide members of the
general public with a direct response and feedback upon service improvements.
Examples of some of the feedback received from the patient opinion website:
To ensure quality assurance for the organisation patient representatives are empowered to voice their opinions, views and active participate within decision making within every Committee, Service Boards and Trust Board within the organisation to ensure that public money is well spent.
What a lovely new hospital.
The security men were
extremely nice and helpful
chaps. What could be
improved? Nothing. Keep up
the good work
I was treated so well and
with so much care. Every
person was dedicated to
helping patients and very
much cared. The Hospital
wards were spotless clean
and food was great
We did…….
We have introduced a single point of care across the
health economy. The service has Advanced Nurse
Practitioners who are skilled to provide clinical
assessments. This has ensured that the patient is in the
right place at the right time, receiving effective and high
quality community health care and prevents patients
having to go into the Acute Hospital..
40
PART FIVE Continually Learning
5.1 Participation in clinical audits
During 2010/11, 2 national clinical audits and 0 national confidential enquiries covered NHS services that SoTCHS provide. During the period SoTCHS participated in 100% national clinical audits and 0% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that SoTCHS was eligible to participate and actually participated in during 2010/11 are as follows:
National Audit Participation Number of Cases Submitted
Royal College of Physicians (RCP) National
Sentinel Stroke Organisational Audit Yes 88 case notes reviewed in conjunction with University
Hospital of North Staffordshire submission
Royal College of Physicians (RCP) National
Clinical Audit of Falls and Bones
Yes Information submitted in conjunction with University
Hospital of North Staffordshire submission
The national clinical audits and national confidential enquiries that SoTCHS participated in, and for which data collection was completed during 2010/11, are listed above alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry where applicable. The reports of the two national clinical audits were reviewed by the provider in 2010/11 and SoTCHS are implementing resultant actions to improve the quality of healthcare provided.
5.2 Participation in clinical research
The number of patients receiving NHS services provided or sub‐contracted by SoTCHS in 2010/11 that were
recruited during that period to participate in research approved by a research ethics committee was 30. The
tables in Appendix I provide details of the current recruiting trials and future trials.
41
5.3 Local Audit
A proportion of Local Audits were completed by the University Hospital of North Staffordshire Clinical Audit department programme that incorporated the Commissioning for Quality and Innovation (CQUIN) Payment framework. The reports of a further twenty local clinical audits were reviewed by the provider in 2010/11 and SoTCHS intends to implement resultant actions to improve the quality of healthcare provided. Listed in the preceding tables are details of the local audits conducted. Listed below are examples of actions that have been implemented to improve the quality of healthcare provided around clinical effectiveness and patient safety:
Reduction of inappropriate antimicrobial prescribing in out‐of‐hours dental service
To measure effective hand washing is being done in clinics
To ensure Patient Group Directives are being used correctly and appropriately
Ensuring records are compliant with the Essence of Care Standards for record keeping
Seven further programmes of local internal audit by external review have been implemented and lead by RSM
Tenon, these audits are detailed below.
Audit Title Stage One Stage Two
Review of the Service Boards July 2010 December 2010
Care Quality Commission –
Registration and Periodic Review July 2010 February 2011
Patient Property Safekeeping October 2010 N/A
Charitable Funds – Ward
Administration October 2010 N/A
Bank and Agency February /March 2011 N/A
Data Quality Validation Processes
(activity and quality) February 2011 N/A
Information Governance August 2010 N/A
42
STOKE‐ON‐TRENT COMMUNITY HEALTH SERVICES REGISTER OF LOCAL CLINICAL AUDITS NOT INCLUDED ON THE UHNS AUDIT PROGRAMME
Title of Audit Audit background Aim/objective of the audit Summarise key recommendations/findings of the
audit
Summarise changes made to services as a result of audit findings
Royal College of Physicians (RCP) Stroke Sentinel Organisational Audit
The RCP Stroke Sentinel Organisational Audit has been measuring the organisation of stroke services since 1998. It uses evidence based guidelines to measure stroke services against.
Audit against the National Clinical Guideline for Stroke and the National Stroke Strategy; To enable Trusts to benchmark their quality regionally and nationally; Measure rate of change in stroke service organisation; Measure the extent that previous recommendations are implemented; Measure progress in providing hyper acute services and measure provision of specialist stroke services in the community.
Royal College of Physicians (RCP) report listed the Top Ten Recommendations
Royal College of Physicians (RCP) report listed the Top Ten Recommendations
Royal College of Physicians (RCP) Clinical Audit
The RCP Stroke Sentinel Clinical Audit has been measuring clinical care since 1998, using evidence based guidelines to measure against.
Audit against the National Clinical Guideline for stroke and the National Stroke Strategy; To enable Trusts to benchmark their quality regionally and nationally; Measure rate of change in service provision since 2008 and the extent of which recommendations made in 2008 have been implemented
Royal College of Physicians (RCP) Clinical Audit recommendations
Royal College of Physicians (RCP) Clinical Audit recommendations
Audit of Repeat General Anaesthetic Administration
As per audit report As per audit report As per attached audit report Action plan implemented
Audit of the Quality of Radiographs
As per audit report As per audit report As per attached audit report Action plan implemented
43
Audit of antimicrobial prescribing
To reduce prescription only courses of treatment in out of hours dental service
Reduction of inappropriate antimicrobial prescribing in out of hours dental service
Not yet available Not yet available
Audit of Delivering Better Oral Health ‐ National Guidance
To assess compliance with Delivering Better Oral Health national guidance
As before Not yet available Not yet available
Decontamination Audit To assess current compliance with decontamination guidance HTM 01‐05
As before Action plan produced and forwarded to IPCC
Working towards best practice as outlined in document
Fraser Guidelines/LARC/Chlamydia Record Audit
Records need to show that fraser guidelines have been followed, LARC & Chlamydia screening is offered to meet national guidance
To ensure records are completed correctly and that patients are offered informed choice
Not yet available Not yet available
Quick Start Oral Contraceptive Pill
Recent recommendations from the FSRH state that patients should be give the option to quick start oral contraception following EHC. This needs to be implemented in CASH clinics
To ascertain whether patients are given the choice to quick start contraception
Not yet available Not yet available
Hand washing Hand washing is an integral part of infection control and should be monitored in CASH clinics
To measure is effective hand washing is being done in clinics
Not yet available Not yet available
Audit of updated Patient Group Directions
PGDs have been updated and training will be give to staff in use of these before their implantation.
To ensure PGDs are being used correctly and appropriately.
Not yet available Not yet available
Audit of new Patient Group Direction
A new PGD has been written for emergency hormonal contraception.
To ensure records are completed correctly and that patients are offered informed choice
Not yet available Not yet available
44
Record Keeping Audit A new paper based system has been developed for the YPSS as a result of a recent change to record keeping systems
To ensure records are compliant with the Essence of Care Standards for record keeping
Current record keeping compliancy 42%. An action plan has been devised as a result of the audit and a re‐audit will be completed July 2011 to review EOC compliancy
New admin processes and structures are being developed as a result of the audit to ensure every client case file is contemporaneous and to ensure record keeping standards are of a good quality
Review of Bleeding Problems with Implanon® (Progestogen Only Implant)
Currently the only progestogen implant licensed for use as contraception in the UK is theetonogestrel (ENG) implant (Implanon®). Altered bleeding patterns are common among women using progestogen‐only implants, sometimes causing the women to request that they are removed.
To improve the management of women who suffer from problematic bleeding due to progestogen only implants (Implanon®).
• Total number of patients having problems was only 29% which is encouraging to continue this very efficient LARC method. Although they were presenting with problems on an average of 4 months and the mean removal time was 7 months.
• All clinical staff provide initial patient counselling which emphasises and clarifies the expected side effects of Implanon® and encourage long term use.• Better documentation and use of Implanon stickers and consent forms to aid documentation.• Increased offer of Chlamydia screening to those presenting with bleeding problems with Implanon.
Chlamydia Screening Team Outreach methodology
Outreach methodology As per audit report Not yet available Not yet available
Chlamydia Screening Team Outreach methodology
Outreach methodology As per audit report Not yet available Not yet available
Chlamydia Screening Team Partner Notification
Partner Notification As per audit report Not yet available Not yet available
Asylum Seeker Clinical outcomes of TB screening
Clinical outcomes of TB screening more follow up of strongly positive patients required
more robust measure to track non attendees from high risk group
Essence of Care National Benchmarking Audit against national standards and develop action plans as required.
Action plan only available As per action plans provided.
Essence of Care National Benchmarking Audit against national standards and develop action plans as required.
Action plan only available As per action plans provided.
45
PART SIX A Listening Organisation
6.1 Reporting Complaints/Compliments (1 April 2010 to 31 March 2011)
To gain assurance within SoTCHS that the organisation truly understands what the patients and staff are saying
about our services, multiple strands of data is captured. Throughout the organisation patient and staff surveys, real
time experience data are triangulated with incidents, complaints and compliments to identify correlated themes or
trends within service provisions. The selection of questions within the patient surveys all reflect key patient
experience priorities identified by members of the general public.
SoTCHS ensures reasonable measures to capture the patient/family experience of all equality characteristics.
Multiple communication strategies are implemented to meet the needs of a diverse population. Information is
provided through communication strategies of staff support, public engagement sessions, information within
multiple languages, Mackron communication boards, dictaphones, interpreters, large font print, loop ear
communication systems and through use of websites.
Service boards are presented with their monthly patient feedback results and create and monitor action plans of
service improvement, all action plans then gain consultation by the Patient and Public Involvement (PPI)
Committee. Monitoring and approval of patient feedback is presented to the monthly Clinical Governance
Committee and submitted to Provider Board as part of the Ward to Board Report. Results of patient’s feedback
along with areas of service improvements are clearly displayed within the public domain on notice boards within
every ward and in health centres across the city.
Within SoTCHS information on complaints and compliments is used as part of the triangulation process for
establishing the full picture on how well we are doing.
Top 3 complaint categories
Podiatry 79
Community Hospitals ‐ Inpatient 14
District Nursing 11
6.1.1 Ratio of Complaints to Activity
Complaints 79
Activity (appointments) 103,176
Podiatry
Rate per 1000 0.77
Complaints 14
Activity 4,416
Community Hospitals ‐ Inpatient
Rate per 1000 3.17
Complaints 11
Activity (Contacts) 169,451
District Nursing
Rate per 1000 0.06
46
6.1.2 Podiatry
During the previous twelve months there has been a significant increase in Podiatry complaints, and the majority of
these have been with regards to the length of time people are waiting for appointments.
We have identified various factors that have contributed to this situation, from the demand and capacity within the
service to the ever increasing older population.
In response to the concerns and challenges faced within the Podiatry Service an external service review has been
commissioned and recommendations are now being implemented by the clinical teams.
6.1.3 Community Hospitals and District Nursing
These complaints do not specifically identify any trends or areas of concern. The main topics of concern are clinical
treatment, attitude of staff and failure to follow procedure. However, there is a recurrent theme throughout to the
use of effective communication and good note keeping. These have both created a number of learning points one
of which led to the creation of a new multi disciplinary care plan that has been implemented to support good
practice in relation to communicating with patients and family members.
Examples of various learning actions implemented following complaints include a spectrum of service changes and
processes from the improved training and standardised operating procedure for the insertion of Naso gastric tubes
to the alterations to the organisations telephone system.
6.1.4 Reporting Compliments
Compliments are an important area to support our staff and to all Service Boards are encouraged to feedback as
much as possible to their Line Managers in order to capture and learn from the good practice of individual teams.
Patient Stories – are also provided to the Provider Trust Board as a standing agenda item.
Top 3 compliments
Community Hospitals ‐ Inpatient 61
Community Hospitals ‐ Outpatients 37
Health Visiting 30
47
Some examples of what our patients say about us –
From the Haywood Hospital “Thank you for all your patience looking after E, I know she's been a handful at
times!!”
“I need to thank you for your part in a day I thought would never happen. In early October I believed that Mum would not reach her 90th birthday. As the days moved on it looked possible. At Haywood I knew she'd do it but I didn’t expect celebrations for her special day.”
From Intermediate Care Team ‐ These people...are professional, caring and friendly...and we as a family feel very
safe that they are in 'excellent hands'.
From District Nursing – DN visited Stepfather and found that mother was nearly exhausted. Managed to organise
respite and cut through red tape effectively.
From Health Visiting ‐ "She has had a very good experience with one of your Mum2Mum coordinators both at
the hospital and home. She has nothing but praise for the service and has received lots of help and support"
From Occupational Therapy – Daughter grateful for OT support during her father's final days. " Thank you for all
you did for us while we got Dad home ‐ we couldn't have had those few last precious weeks without you, and
they mean so much now that he's gone.”
From Physiotherapy ‐ Lady wrote in to compliment a member of staff who runs Rehab classes at Tunstall Floral
Hall on a weekly basis. "He has an excellent manner and rapport with everyone who attends treating each
person individually."
From Podiatry ‐ I have just seen a patient that you saw when you were at Meir some time ago. She wants me to
tell you that she is very grateful to you for the excellent treatment you gave her. You enucleated a painful
plantar corn, and she said it has never returned.
48
PART SEVEN Registration and External Review
7.1 Care Quality Commission
Stoke‐on‐Trent Primary Care Trust has two roles. They commission care services for the local population and
provide services directly through SoTCHS.
Stoke on Trent Primary Care Trust is required to register with the Care Quality Commission and its current
registration as of 31st March 2011 is ‘Registered without condition’. The Care Quality Commission has not taken
any enforcement action against Stoke on Trent Primary Care Trust during the reporting period of 1st April 2010 to
the 31st March 2011.
Stoke on Trent Primary Care Trust has not participated in any special reviews or investigations by the CQC during
this reporting period of 1st April 2010 to the 31st March 2011.
7.2 West Midlands Quality Review Service‐ Local health economy visit
The West Midlands Quality Review Service implemented a Local Health Economy Visit and this incorporated the
Haywood Hospital Walk in Centre.
The feedback obtained stated that this was an excellent service in all respects. Support for patients, staffing,
support services, facilities, guidelines and protocols, and governance were all extremely well organised. A wide
range of services were available, including deep vein thrombosis and fracture clinics. There was a robust training
programme with good ongoing training and mentorship. Data collection to support audit programmes was also
good.
7.3 Serious Case Review
In March 2010, in accordance with “Working Together to Safeguard Children” 2010 (Chapter 8) Stoke‐on‐Trent
Safeguarding Children Board initiated a Serious Case Review.
This was the case of a young infant, subject of a child protection plan who suffered a life‐threatening event as a
result of co‐sleeping with a family member. Sadly the child later died some months later. The child at that time was
subject of a child protection plan
The Independent Chair of the Safeguarding Children Board (SCB) decided that a serious case review should be held
because of concerns about the way in which local professionals and services worked together to protect and
because lessons could be learnt by more than one agency.
The purpose of a Serious Case Review is to:
Establish what lessons to be learnt from the case about the way in which local professionals and organisations/agencies work individually and together to safeguard and promote the welfare of children;
Identify clearly what those lessons are both within and between agencies, how and within what timescales they will be acted on, and what is expected to change as a result; and
Improve intra and inter – agency working and better safeguard and promote the welfare of children and young people.
49
NHS Stoke on Trent, inclusive of SoTCHS and North Staffordshire Community health Service, as a main partner of the SCB conducted a review of health’s involvement with the child and family. Multi‐agency briefings have been made available to all staff in order that lessons are learned across all organisations. As well as multi‐agency, specific recommendations for NHS Stoke on Trent were identified as follows:
That Health Visiting and school nurse records contain full details of contacts with families.
That the time of contacts and who is present be recorded.
That training be given to staff in relation to challenge of other agencies and information sharing.
That all written agreements are available for all agencies to view and that they are considered at all core groups with particular reference to the monitoring process.
That a professionals meeting with parents is held to co‐ordinate input where there are complex needs/ more than 3 professionals are involved.
Implemented Actions
Health Visiting and School Nursing records have been changed as well as ways in which contacts are recorded.
New training programmes have been developed to address this and the other recommendations
The latest guidance with regards to reducing the risk of sudden infant death has been widely re‐distributed.
SoTCHS continue to contribute to the SCB partnership recommendations.
In December the SHA undertook an annual safeguarding children review. Formal feedback identified the following areas of strength and good practice:
PCT financial support for safeguarding has continued and is seen as a priority
Services to prevent sexual exploitation are well developed
The Family Nurse Partnership is recognised nationally and is moving to small scale maintenance
Health colleagues are engaged with the Local Safeguarding Children’s Board (LSCB) and Serious Case Reviews
Peer audit of section 11 Audits is forward thinking and is seen as emerging good practice for safeguarding
Child protection supervision is well established
There is a clear Serious Case Review (SCR) training programme in place to ensure lessons learned
50
PART EIGHT Transparent and Open
8.1 Incident Reporting
Paramount to improving quality is patient safety. Information provided by the National Patient Safety Agency
(NPSA) demonstrates that SoTCHS has a good incident reporting culture where staff feel able to report
incidents and near misses demonstrating an open culture that supports improvement and learning.
Figure one below demonstrates the sustained incident reporting within SoTCHS during the period of April
2010 – March 2011.
Stoke on Trent Community Health Services Incident Reporting April 2010 ‐
March 2011
141169 179
200179 193 192 201 199 209
181219
0
50
100
150
200
250
Apr‐
10
May‐
10
Jun‐10 Jul‐10 Aug‐
10
Sep‐
10
Oct‐10 Nov‐
10
Dec‐
10
Jan‐11 Feb‐
11
Mar‐
11
Figure two below compares the incidents that occurred between 1 April and 30 September 2010 that were reported to the National Reporting and Learning System to the previous years reporting period 1st April 2009 and 30th September 2009. This clearly demonstrates the improved reporting culture and development for the organisation;
Figure 2
1st April 2009 – 30th September 2009
1st October 2009 – 31st March 2010
1st April 2010 – 30th September 2010
Number of Incidents Reported
204 225 438
Reported Incidents per 1,000 Bed days
15.8 17.5 20.45
51
The NPSA found that organisations with higher rates of reporting incidents are safer Trusts. Further information can
be obtained through the NPSA.
Of the incidents reported, 57% were reported as ‘no harm’ to patients. This indicates a positive cultural approach
to reporting and responding to potential incidents.
Table1 below highlights the top 5 reported clinical incident types from April 2010 ‐March 2011.
Clinical Adverse Incidents Total Number Reported
1.Slips, Trips and Falls 483
2.Pressure Sores 372
3.Abuse/Nuisance/ Violence 144
4.Clinical Care / Procedure / Treatment 127
5.Medication / Drug Issue 122
Table 1
Incident reporting for SoTCHS is further broken down into individual service board monthly reports. This enables
the organisation to take a more targeted approach to incidents reported within these areas enabling further
examination to identify common themes, trends and if required the completion of root cause analysis investigation
and appropriate resolving action plans to implement the required changes into practice.
By providing this level of detail to the
Service boards it provides the ability to
monitor and implement resolving
action plans. These will then be
reported on a quarterly basis to the
Clinical Governance Committee which
provides assurance on the
management of incidents and
monitoring of action plan progress.
This level of reporting enables the
Provider Board to seek assurance that
incidents are being monitored,
actioned, reported and investigated
appropriately and changes are
implemented in order to provide safer
services for our patients.
Service Board Incidents 2010 - 2011
0
20
40
60
80
100
120
140
Apr-1
0
May
-10
Jun-
10
Jul-1
0
Aug-1
0
Sep-1
0
Oct-
10
Nov-1
0
Dec-1
0
Jan-
11
Feb-1
1
Mar
-11
Adults
Childrens
Hospital
Sexual Health
52
8.2 Alerts
National Alerts are issued to appropriate NHS Organisations through the Central Alerting System (CAS) for the
following:
NPSA (National Patient Safety Agency), Rapid Response Reports (RRR) and Safer Practice Notices (SPN)
Drug Alerts
Medical Device Alerts (MDA)
Chief Medical Officer Letters (CMO)
Counter Fraud Security Management Services for Security Alerts (CFSMS)
Medicines and Healthcare Products regulatory Agency (MHRA)
These alerts are assessed for relevance to the organisation and cascaded to appropriate service leads for action and
traced though the safeguard system and reported back as closed once the alert has been assessed and relevant
action has been taken by the organisation.
The table below summarises all SoTCHS alerts for April 2010 to March 2011 and the current status of those alerts:
Number of Alerts Issued 209
Number of Alerts Open, within timescale (On Time) 6
Number of Alerts Open, outside timescale (Late) 0
Number of Central Alerts Issued and Closed April 2010 ‐ March 2011
12
8
22
11
37
15 1412
1417 17
30
36
15 15 16
26
15
10
22
16
20
26
13
6
0
5
10
15
20
25
30
35
40
Apr‐10 May‐10 Jun‐10 Jul‐10 Aug‐10 Sep‐10 Oct‐10 Nov‐10 Dec‐10 Jan‐11 Feb‐11 Mar‐11 Apr‐11
Alerts Issued
Alerts Closed
Alerts Open within Timescales
53
8.3 NHSLA
In March 2010 Stoke on Trent PCT was assessed against the NHS Litigation Authority standards. These standards
require Trusts to have in place a set of policies which meet certain standards and then to show that these policies
have been implemented and monitored to ensure that care and support is delivered in line with policies.
Stoke on Trent PCT was assessed for Level One of the standards which measures that the appropriate policies are in
place. Stoke on Trent PCT achieved NHSLA Level 1 National Health Service Litigation Authority Compliance. For the
reporting period of 2010/2011 the organisation has ensured that concurrent action plans have been implemented
and are continual in order to maintain the level 1 compliance.
8.4 Learning from our Actions:
As an organisation we continually strive to improve our assurance processes and to meet the needs of our local
population, however sadly sometimes we do not always get this right. Lessons have been learnt from the two
issues described below and we are fully committed to learning from instances where, we did get it wrong, and will
continue to work with our partners and strive to improve quality of service provision across all services.
Adult Safeguarding
Regrettably in January 2010 we had a whistle blowing incident involving one of our wards at the Haywood Hospital.
Allegations were made that the care delivered to patients was not consistent resulting in immediate measures
being taken to improve the standards of nursing care provided on the ward. An Adult Safeguarding investigation
was undertaken, as per locally agreed policies and procedures. In addition, internal investigations have taken place
and appropriate disciplinary actions taken. Recently additional evidence has been presented to the Adult
Safeguarding Team and further enquires are being made. All affected patient family members have been
communicated with and the organisation has apologised for the care that was not delivered to a high standard.
Podiatry
As previously stated earlier in the report, during the last 12 months there has been a significant increase in
complaints in relation to the podiatry service, due to the length of time which people were waiting for
appointments. A review of the podiatry service has now been undertaken and significant changes are being
implemented.
The service changes have been agreed by NHS Stoke on Trent and the General Practice Consortia. Patient Focus
Groups were also involved in the review. The changes have been considered by the Overview Strategy Committee.
People are now being re‐assessed for their continued clinical need for specialist podiatry care.
Their vulnerability and social circumstances are also part of the review process. The assessments mean that
appropriate people are now being discharged from the service but with information on how to care for their feet.
They are also informed how they can be referred back to the service if their needs change.
A Quality Assurance Programme is in place to monitor the impact of the changes.
54
PART NINE: Statements from Primary Care Trusts, Local Involvement Networks and Overview and Scrutiny Committees
9.1 NHS Stoke‐on‐Trent
This is the first time that providers of community services have been required to produce a Quality Account. As the
main commissioner of services for Stoke‐on‐Trent Community Health Services, NHS Stoke is pleased to comment
on the Quality Account for 2010/11.
As part of the contract monitoring process, NHS Stoke commissioners meet bi‐monthly with Stoke‐on‐Trent
Community Health Services to monitor and seek assurance on the quality of services provided. In addition to these
formal Clinical Quality Review Meetings, sub groups focusing on serious incidents and CQUINS have been
introduced during 2010/11. The Quality Account covers many of the areas that are discussed at these meetings
which seek to ensure that patients receive safe high quality care.
In looking forward to the formation of the Staffordshire and Stoke‐on‐Trent Partnership NHS Trust the Clinical
Quality Review Meetings for NHS North Staffordshire and NHS Stoke have been merged since April 2011, with a
view to further merger with South Staffordshire in the summer.
In relation to CQUINS, the PCT recognises the commitment of Stoke‐on‐Trent Community Health Services to
progress the quality agenda which has resulted in a positive performance outcome against the agreed CQUIN
measures.
The PCT has worked closely with the provider to agree quality improvements for 2011/12 using the CQUIN
framework. The agreed key focus supports the national QIPP focus on safety, including the roll out of Safety
Express which covers areas such as falls, tissue viability, VTEs and catheter care.
From a patient/public perspective it may be that the Quality Account is considered to be rather a lengthy read, it
does, however, provide a good insight into the comprehensive range of quality improvement activities and
initiatives that have been undertaken during the year.
Having reviewed the information in the Quality Account against the information the PCT and its partners have on
the areas covered, the PCT is happy to confirm that the information provided in the Quality Account is accurate.
The PCT is also happy to confirm that the account provides a balanced reflection of the quality of services provided.
55
9.2 Staffordshire Health Overview and Scrutiny Committee
We are directed to consider whether a Trust’s Quality Account is representative and gives comprehensive coverage
of their services and whether we believe that there are significant omissions of issues of concern.
Our approach has been to review the Trust’s draft Account and make comments for them to consider in finalising
the publication, before providing this final commentary.
There are some sections of information that the Trust must include and some sections where they can choose what
to include. We focused on what we might expect to see in the Quality Account, based on the guidance that trusts
are given and what we have learned about the Trust’s services through health scrutiny activity in the last year. We
also considered how clearly the Trust’s draft Account explains for a public audience (with evidence and examples)
what they are doing well, where improvement is needed and what will be the priorities for the coming year. We
were expecting this year’s Quality Accounts to demonstrate increasing patient and public involvement in the
assessment and improvement of the quality of services that health trusts provide.
We are pleased that, as a result of our comments, the Trust has:
Liaised with the other Primary Care Trust provider services in the county to give a consistent explanation about the governance of quality during the transition to the new Partnership NHS Trust;
Clarified the Commissioning for Quality and Innovation (CQUIN) income achieved;
Included the next step for information governance;
Explained the audit relationship with University Hospital of North Staffordshire NHS Trust and added some detail about audit outcomes; and
Explained the February dip in MRSA screening compliance.
Whilst the draft we saw was well written and presented, in the final Account we would have liked to see:
A short introduction to the Trust including a list of services;
A reference in Part One to who was involved in developing the Account;
Text to accompany the useful tick charts and Ward to Board graph to explain any off target performance or notable good practice;
A couple of worked examples of how clinical trials have led to improved care quality;
An illustrative example of an improvement made as a result of discharge feedback; and
A couple of illustrative service examples of learning from incidents to improve patient care.
9.3 Stoke‐on‐Trent Health Overview and Scrutiny Committee
Due to the timing of the Stoke‐on‐Trent City Council Elections and the publication of the Quality Accounts, the Scrutiny Committee for Health Issues has not been able to consider Stoke‐on‐Trent Community Health Services 2010/11 Quality Account.
56
9.4 Staffordshire Local Involvement Network (LINk)
An early approach was made to Staffordshire LINk by Stoke‐on‐Trent Community Health Services with a copy of the
draft Quality Account for initial comment by Staffordshire LINk. Staffordshire LINk appreciated this early
involvement and promoted the opportunity for LINk participants to comment on the draft as well as the
opportunity to attend a meeting with Trust representatives to go through the draft account and provide comments
and feedback.
A joint presentation meeting was held with representatives from both Staffordshire and Stoke‐on‐Trent LINk at
which representatives of North Staffordshire Community Healthcare and Stoke‐on‐Trent Community Health
Services presented their draft Quality Accounts which enabled LINk participants to raise questions and provide
comments and feedback into the format of the account and suggestions for improvements to the way the
information was presented. L INk participants appreciated being able to contribute to this early consultation phase
in the production of the Trust’s Quality Account.
The Quality Account follows the format and the wording of some paragraphs as prescribed by the DH and this
results in some technical information that may be difficult for some members of the public to understand however,
the overall impression of this final draft is that it is easy to read with the information being presented in a clear and
logical manner with the “Indicators” namely ticks () and crosses () are a simple and effective way of portraying
the information.
Some concern was noted that it is reported in Part Two: Priorities for improvement Section 2.6.2 that target
performance has not been achieved in two areas and these are noted with two red crosses () in respect of 1: “%
of deaths occurring in preferred place (target 40%) – 38% achieved” and 2: “Sickness and absence of staff (target
4.5% ‐ 5.46% achieved” although LINk participants noted the quality improvement objectives on page 10 and feel
confident that these issues will be addressed.
Staffordshire LINk would wish to thank Stoke on Trent Community Health Services for providing this opportunity to
comment on the Quality Account.
9.5 Stoke‐on‐Trent Local Involvement Network (LINk)
A formal presentation was held on the 5th May 2011 with representatives from Stoke on Trent Local Involvement
Network at which Stoke on Trent Community Health Services presented the draft Quality Accounts. This enabled
Stoke on Trent Local Involvement Network participants to raise questions and provide comments and feedback at
the time of presentation.
9.6 Stoke‐on‐Trent Community Health Voice
A formal presentation was made to the Stoke‐on‐Trent Community Health Voice at a meeting on the 19th May 2011
at which Stoke‐on‐Trent Community Health Services presented the draft Quality Accounts. This enabled Stoke‐on‐
Trent Community Health Voice members to raise questions and provide comments and feedback on the format of
the Accounts, which has also provided further suggestions for improvements to future reporting.
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PROVIDING FEEDBACK ON THIS ACCOUNT:
Your Views, Your Involvement Thank you for taking the time to read Stoke‐on‐Trent Community Health Services first published Quality Account. We hope that you have found it interesting and enjoyable to read. If you would like further information, or to comment on any aspect of this Account and give us feedback, please write to: Longton Cottage Hospital Upper Belgrave Road Stoke on Trent ST3 4QX Or contact 0300 123 0995 4400 To view this account electronically, please visit our website at www.stoke.nhs.uk, or NHS Choices at www.nhs.uk The organisation has access to interpreting and translation services. If you require information in another language or format, we will do our best to meet your needs. Pease contact Patient Advice and Liaison on 0800 783 2865.
We look forward to receiving your comments and suggestions
If you would like this information in another language or format please contact Stoke-on-Trent Community Health Services on 0300 123 0995 4400.
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APPENDIX 1 – Clinical Trials
Recruiting Trials
Trial Status
Function Study A multicentre, four‐arm, double‐blind, double dummy, randomised parallel group study comparing treatment with tocilizumab either as monotherapy or in combination with MTX, to MTX in patients with early, moderate to severe RA who have not yet been treated with a biologic agent
Sponsor – Roche Pharmaceuticals Ethics Approval – 15/2/2010 R&D Approval – 27/04/2010 Start Date – March 2010 End Date ‐ May 2011
Patients Screened 4, Recruited 2 Identified Mar 2011 ‐ 2
TRACE RA Trial of atorvastatin for the primary prevention of cardiovascular events in RA
Sponsor – University of Manchester Ethics Approval – 2008 R&D Approval – 2009 Start Date – June 2010 End Date ‐ June 2011
Patients Recruited 28
Orbit Study Optimising treatment with tumour necrosis factor inhibitors in RA. Dose tapering in good responders. This is a proof of principle and exploratory trial
Sponsor – Roche Pharmaceuticals Ethics Approval – Jan 2011 R&D Approval – Mar 2011 Start Date – May 2011 End Date – May 2013
Patients Identified 2, Screened 0, Recruited 0
NNC8 Study (A humanised recombinant immunoglobulin, that targets C5A r receptor) This is a randomised, double‐blind, placebo controlled trial for patients with RA.
Sponsor ‐ Novo‐Nordisk Ethics Approval – Dec 2010 R&D Approval – Feb 2011 Start Date – March 2011 End Date – March 2012
Patients Identified 3, Screened 0, Recruited 0 Recruited 0
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Future Trials
Trial
Status
Oskira 2 The primary objective of this study is to evaluate the efficacy of 2 oral dosing regimens of FosD. Reg A ‐100mg twice daily (bid) Reg B – induction with 100mg bid for the fist 4 weeks, 150mg once daily (qd) – maintenance thereafter, taken in combination with a disease‐modifying anti rheumatic drug (DMARD) compared with placebo plus a DMARD in patients with active RA by assessment of 20% response criteria (ACR 20) at wk 24. Sponsor ‐ AstraZeneca
Ethics Approval Granted Contract/budget approved Awaiting R&D Approval
Oskira 3 The primary objective of this study is to evaluate the efficacy of 2 oral dosing regimens of FosD. Reg A – 100mg twice daily (bid), Reg B – induction with 100mg bid for the first 4 weeks, 150mg once daily (qd) – maintenance thereafter. Taken in combination with MTX , compared with placebo plus MTX in patients with active RA who have had inadequate response to a single tumour necrosis factor‐alpha TNF) antagonist by assessment of:
- The signs and symptoms of RA, as measured by the ACR 20 at week 24.
Sponsor ‐ AstraZeneca
Ethics Approval Granted Contract/budget approved Awaiting R&D Approval
Oskira X The primary objective of this study is to evaluate the long‐term safety and tolerability of FosD In patients with active RA by assessment of adverse event, lab safety data, vital signs, ECGs, and physical examination. Sponsor ‐ AstraZeneca
Ethics Approval Granted Contract/budget approved Awaiting R&D Approval
Tabul Study Investigation – The role of ultrasound compared to biopsy of temporal arteries in the diagnosis and treatment of Giant Cell Arteritis. Sponsor ‐ NHIR
Ethics Approval Granted Awaiting R&D Approval
Builder 1 Study Treatment ‐ Tocilizumab Population – Ankylosing Spondylitis patients who are anti‐TNF naïve Sponsor – Roche Pharmaceuticals
Awaiting R&D Approval Contracts/budget approved
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Builder 2 Study Treatment ‐ Tocilizumab Population ‐ Ankylosing Spondylitis patients. Design – Randomised, double blind, placebo controlled 24 week trial with open label FU Sponsor – Roche Pharmaceuticals
Awaiting R&D Approval Contracts/budgets approved
Palace 3 Study A Phase 3, Multicenter, Randomized, Double‐blind, Placebo‐controlled, Parallel‐group, Efficacy and Safety Study of Two Doses of Apremilast (CC‐10004) in Subjects with Active Psoriatic Arthritis and a Qualifying Psoriasis Lesion Sponsor ‐ Celegene
Ethics Approval Granted Awaiting R&D Approval Contracts/budget approved
Palace 4 Study A Phase 3, Multicenter, Randomized, Double‐blind, Placebo‐controlled, Parallel‐group, Efficacy and Safety Study of Two Doses of Apremilast (CC‐10004) in Subjects with Active Psoriatic Arthritis Who Have Not Been Previously Treated with Disease‐modifying Antirheumatic Drugs Sponsor ‐ Celgene
Ethics Approval Granted Awaiting R&D Approval Contracts/budget approved
Genetics in AS Using modern laboratory techniques the Botnar research centre they identify the most important genes involved in diseases like AS. The Unit has already identified several AS genes that have given a clearer understanding of the process by which AS develops. The goal is to identify as many of these genes as possible to enable a better understanding of the disease and develop better ways of diagnosing and treating it. Sponsor – Botnar Research Centre
Ethics Approval Granted Awaiting R&D Approval
Patient Counselling Study To determine patient existing knowledge and attitudes towards pre‐therapy counselling for anti‐TNF therapy in three areas of particular interest. Sponsor – Haywood Foundation Ethics Approval – April 2011
Awaiting R&D Approval
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APPENDIX 2 – Glossary of Terms
Provider Services A Provider is an NHS organisation responsible for providing a group of healthcare services. A provider provides services within a community or community hospital setting. Audit Commission The Audit Commission regulates the proper control of public finances by local authorities and the NHS in England and Wales. The Commission audits NHS Trusts; primary care Trusts and strategic health authorities to review the quality of their financial systems. It also publishes independent reports which highlight risks and good practice to improve the quality of financial management in the health service, and, working with the Care Quality Commission, undertakes national value‐formoney studies. Visit: www.audit‐commission.gov.uk/Pages/default.aspx Board (of Provider) The role of the board is to take corporate responsibility for the organisation’s strategies and actions. The chair and non‐executive directors are lay people drawn from the local community and are accountable to the Secretary of State. The Managing Director is responsible for ensuring that the board is empowered to govern the organisation and to deliver its objectives. Care Quality Commission The Care Quality Commission (CQC) replaced the Healthcare Commission, Mental Health Act Commission and the Commission for Social Care Inspection in April 2009. The CQC is the independent regulator of health and social care in England. It regulates health and adult social care services, whether provided by the NHS, local authorities, private companies or voluntary organisations. Visit: www.cqc.org.uk Clinical Audit Clinical audit measures the quality of care and services against agreed standards and suggests or makes improvements where necessary. Clinical Coding Clinical coding translates the medical terminology written by clinicians to describe a patient’s diagnosis and treatment into standard, recognised codes. The accuracy of coding is an indicator of the accuracy of the patient’s health record. Commissioners Commissioners are responsible for ensuring adequate services are available for their local population by assessing needs and purchasing services. Primary care Trusts are the key organisations responsible for commissioning healthcare services for their area. They commission services (including acute care, primary care and mental healthcare) for the whole of their population, with a view to improving their population’s health. Commissioning for Quality and Innovation (CQUIN) High Quality Care for All included a commitment to make a proportion of providers’ income conditional on quality and innovation, through the Commissioning for Quality and Innovation (CQUIN) payment framework. Health Act An Act of Parliament is a law, enforced in all areas of the UK where it is applicable. The Health Act 2009 received Royal Assent on 12 November 2009. Healthcare Healthcare includes all forms of healthcare provided for individuals, whether relating to physical or mental health, and includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition, for example cosmetic surgery. .
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High Quality Care for All High Quality Care for All, published in June 2008, was the final report of the NHS Next Stage Review, a year‐long process led by Lord Darzi, a respected and renowned surgeon, and around 2000 frontline staff, which involved 60,000 NHS staff, patients, stakeholders and members of the public. Local Involvement Networks (LINks) Local Involvement Networks (LINks) are made up of individuals and community groups which work together to improve local services. Their job is to find out what the public like and dislike about local health and social care. They will then work with the people who plan and run these services to improve them. This may involve talking directly to healthcare professionals about a service that is not being offered or suggesting ways in which an existing service could be made better. LINks also have powers to help with the tasks and to make sure changes happen. NCEPOD ‐ National Confidential Enquiries into Patient Outcome and Death NCEPOD's purpose is to assist in maintaining and improving standards of medical and surgical care for the benefit of the public by reviewing the management of patients, by undertaking confidential surveys and research, and by maintaining and improving the quality of patient care and by publishing and generally making available the results of such activities. National Patient Safety Agency The National Patient Safety Agency is an arm’s‐length body of the Department of Health, responsible for promoting patient safety wherever the NHS provides care. National research Ethics Service The National Research Ethics Service is part of the National Patient Safety Agency. It provides a robust ethical review of clinical trials to protect the safety, dignity and well‐being of research participants as well as ensure through the delivery of a professional service that it is also able to promote and facilitate ethical research within the NHS. NHS Choices A website for the public for all information on the NHS. NHS Next Stage Review A review led by Lord Darzi. This was primarily a locally led process, with clinicalvisions published by each region of the NHS in May 2008 and a national enabling report, High Quality Care for All, published in June 2008. The National Institute for Health and Clinical Excellence (NICE) Provides guidance, sets quality standards and manages a national database to improve people’s health and prevent and treat ill health. NICE makes recommendations to the NHS on:
new and existing medicines, treatments and procedures
treating and caring for people with specific diseases and conditions. Overview and Scrutiny Committees Since January 2003, every local authority with responsibilities for social services (150 in all) has had the power to scrutinise local health services. Overview and scrutiny committees take on the role of scrutiny of the NHS – not just major changes but the ongoing operation and planning of services. They bring democratic accountability into healthcare decisions and make the NHS more publicly accountable and responsive to local communities. Periodic reviews Periodic reviews are reviews of health services carried out by the Care Quality Commission (CQC). The term ‘review’ refers to an assessment of the quality of a service or the impact of a range of commissioned services, using the information that the CQC holds about them, including the views of people who use those services. Visit: www.cqc.org.uk/guidanceforprofessionals/healthcare/nhsstaff/periodicreview2009/10.cfm
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Primary Care Trust A primary care Trust is an NHS organisation responsible for improving the health of local people, developing services provided by local GPs and their teams (called primary care) and making sure that other appropriate health services are in place to meet local people’s needs. Registration From April 2009, every NHS Trust that provides healthcare directly to patients must be registered with the Care Quality Commission (CQC). In 2009/10, the CQC is registering Trusts on the basis of their performance in infection control. Research Clinical research and clinical trials are an everyday part of the NHS. The people who do research are mostly the same doctors and other health professionals who treat people. A clinical trial is a particular type of research that tests one treatment against another. It may involve either patients or people in good health, or both. Special Review A special review is a review carried out by the Care Quality Commission (CQC). Special reviews and studies are projects that look at themes in health and social care. They focus on services, pathways of care or groups of people. A review will usually result in assessments by the CQC of local health and social care organisations. A study will usually result in national‐level findings based on the CQC’s research. Strategic Health Authorities Strategic Health Authorities (SHAs) were created by the Government in 2002 to manage the local NHS on behalf of the Secretary of State. SHAs manage the NHS locally and are a key link between the Department of Health and the NHS SHAs (there are ten in total) are responsible for: • developing plans for improving health services in their local area; • making sure that local health services are of a high quality and are performing well; • increasing the capacity of local health services – so they can provide more services; and • Making sure those national priorities – for example, programmes for improving cancer services – are integrated into local health service plans. Glossary courtesy of Department of Health, Quality Accounts toolkit, advisory guidance for providers of NHS Services producing Quality Accounts for the year 2010/2011